542 - Laserfiche WebLink

Home Browse Search

. w APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. / I A d JOB ADDRESS AND LOCATION-- ----- ip----- - �-_------- ri°i -A------------------------------------------------------------------------ ------------ Owner's Name----14Y •4.1� __-l_t ------ +� ---" -- ------ --- ----------------------------------------- ----------- Phone-- zlq_� --_] ------------ Address-------------r7- =l y Yl f -- Contractor's Name------------------------------------------- --------------------------------------- Phone I ------- ?.'y Installation will serve: Residence ❑ Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ;[ ] Number of bedrooms ❑ Number of baths ❑ Lot size----S�----A------------------------------_.......... Water Supply: Public system ❑ Community system ❑ Private ❑ I } Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam IM Clay Loam E] Clay E] Adobe E] Hal' pan ❑ i TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 3 Septic Tank: . Distance from"nearest well________________Distance from foundation--------------------Material---------------------------------_ -___________ ❑ No. of compartments--------------------------Capacity:----------------------Size-------------------------------Liquid depth-------- �f Cesspool: Distance from nearest well __________Distance from, fp nc� � ation___�?!___-__.Lining material_Cee2 7 -------- \ t Size: Diameter--J- -x---� --------------Depth G XL------------------------------ Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ 171 Distance to nearest lot line------------------------------------------------ 1 Seepage Pit: Distance to nearest well________-------------Distance from foundation_____________-____.Distance to nearest lot line_.�__.-___--___-_ ' ❑ Number of pits--------------- ------Lining material----------------------.Size: Diameter------------------------Dep th---_-------------II-_-__�•------ «.Disposal Field: Distance from nearest well-----Q---------Distance from foundation_____ (.___-------Distance to nearest 11 line__Ii_r-_________ -_Number of lines------------- ------------- ---hength of each line--- S^LI_ - -------Width�of trench-----'id------- ---------_----- Type of filter material_4 (------ epth of filter material-----te---___----___ l; Remodeling and/or repairing (describe)-- ----------------------------- ----------------------------------------------'--------- ------------------------- ------------- ----- °--------------- ------------------------------------------------------------------------------------- -----------------------------------------------------------------------------------------------------------------�` - ----------- ____________________ _______________________________________________________________________________________________________________________________________________________________________________________+.r_______--_--_. hereby certify that I have prepared this.application and that the work will be done in accordance with San JoaquiCounty ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. nerand/or CIn#vac#or){Signed)----�------ ------------------------------ -- -------------=- ------------------------------------------------------------------------------------------(Ow By:-----------------------------------------------------------------------------------------------------------------------------------(Title)--------------------------------- --------------- (Plot plans,plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------�dr/ r---- ----- ------------------------------------------------------------ DATE------� _ rG 0�----------1l--------------- k REVIEWED BY - DATE. I BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE-----------------------------------------II--------------- Alterationsand/or recommendations---------------------------- --------------------------------------------------------------------------------------------------------J--------------- ------------------------------------------------------------------------ -!�----------------------------------------------------:-------------- ---------------------------------------------------------I--------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- II------- -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------;--------------- PERMIT No. _ ISSUED____ &_ ___ -___----(Dated FINAL INSPECTION BY:_-_-______ r%_.___- Date--------------------------- - ----------- P = SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street , Stockton, California ES-9-2M 9-50 W=1639